The method of diagnosis in practice is driven by our goal in diagnosis

Jain, Bimal P.,M.D. BJAIN at PARTNERS.ORG
Wed Apr 25 12:52:16 UTC 2018


In this attached paper, I argue that the method of diagnosis in practice, which consists of hypothesis generation and verification, is driven by our goal in diagnosis of diagnostic accuracy in every given, individual patient.
The Bayesian method, in which probability is evidence, is not employed for diagnosis in practice as it leads to diagnostic errors in some patients and thus fails to achieve our goal of diagnostic accuracy in every patient.
The advantages of employing the Bayesian method are not clear to me while it has several disadvantages apart from leading to diagnostic errors in some patients.
It leads to inconsistency in teaching diagnosis to students when we say that the low prior probability of an uncommon disease given a presentation is prior evidence against it in a given patient but ask them to create a comprehensive differential diagnosis which includes diseases with low prior probabilities!
The only reason the Bayesian method was prescribed for diagnosis was its unbounded rationality in inference which has been challenged by concepts of bounded rationality and ecological rationality.
Other disciplines such as economics have moved on and presented and accepted alternative views of economic decision making such as in behavioral economics while we seem to be stuck with the mid 1960s prescription of the Bayesian method in diagnosis despite overwhelming evidence of it   not being used in practice because of it  no being suitable for diagnosis.
The situation seems to be somewhat like persistent belief in a diagnosis in a patient despite lack of any evidence for it.
I believe the status of the Bayesian method for diagnosis is an important issue which should be of interest to all members of SIDM.
Please discuss, comment on this important topic.
Thanks.

Bimal

Bimal P Jain MD
Northshore Medical Center
Lynn MA 01904.


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